title: Delayed and unmet need for medical care among publicly insured adults with disabilities.
abstract: BACKGROUND
  While Medicaid is an important source of insurance coverage for persons with disabilities, barriers remain to accessing care for this population.
  
  
  OBJECTIVE
  This study addresses 3 research questions: (1) do adults with disabilities experience greater unmet need/delayed care?; (2) do barriers related to cost, providers, or structure vary by disability status?; and (3) do barriers mediate the relationship between disability and access to care?
  
  
  METHODS
  Data were obtained from a 2008 stratified random sample of Minnesota Health Care Program's nonelderly adult enrollees (n=1880). The survey was administered by mail, with a telephone follow-up for nonresponders.
  
  
  METHODS
  Disability is defined by self-report. Access to care is measured by reported delayed and unmet need for medical care within the past year. Respondents were asked about their experiences with a variety of cost-related, provider-related, and structural barriers to care.
  
  
  RESULTS
  Respondents with a disability were more likely to experience delayed (40%) and unmet need (23%) for medical care than persons without disabilities (24% and 10%, respectively). Persons with disabilities also reported multiple barriers to health care, especially structural barriers, such as making a timely appointment and accessing transportation (74% vs. 59%). The greater likelihood of facing a structural barrier partially explained increased risk of delayed or unmet care among adults with disabilities.
  
  
  CONCLUSIONS
  Disparities in access to health care based on disability status remain even for persons who have insurance. These disparities deserve further research and policy attention to better address the particular needs of this population.
authors.affiliation: *School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN †VA Medical Center, Augusta, GA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Henning-Smith
authors.forename: Donna
authors.initials: D
authors.lastname: McAlpine
authors.forename: Tetyana
authors.initials: T
authors.lastname: Shippee
authors.forename: Michael
authors.initials: M
authors.lastname: Priebe
mesh_terms: D000328:Adult; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008910:Minnesota; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States